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Semin Neurol 2023; 43(05): 744-757
DOI: 10.1055/s-0043-1775792
Review Article

Prognostication in Prolonged and Chronic Disorders of Consciousness

Julia M. Carlson 
1   Division of Neurocritical Care, Department of Neurology, University of North Carolina Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
David J. Lin 
2   Center for Neurotechnology and Neurorecovery, Division of Neurocritical Care and Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
3   Center for Neurorestoration and Neurotechnology, Rehabilitation Research and Development Service, Department of Veterans Affairs, Providence, Rhode Island
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Abstract

Patients with prolonged disorders of consciousness (DOCs) longer than 28 days may continue to make significant gains and achieve functional recovery. Occasionally, this recovery trajectory may extend past 3 (for nontraumatic etiologies) and 12 months (for traumatic etiologies) into the chronic period. Prognosis is influenced by several factors including state of DOC, etiology, and demographics. There are several testing modalities that may aid prognostication under active investigation including electroencephalography, functional and anatomic magnetic resonance imaging, and event-related potentials. At this time, only one treatment (amantadine) has been routinely recommended to improve functional recovery in prolonged DOC. Given that some patients with prolonged or chronic DOC have the potential to recover both consciousness and functional status, it is important for neurologists experienced in prognostication to remain involved in their care.

Keywords

disorders of consciousness - prognosis - unresponsive wakefulness syndrome - minimally conscious state - coma


Publication History

Article published online:
27 September 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Plum F, Posner JB. The Diagnosis of Stupor and Coma. Oxford: Oxford University Press; 1982
    Search in Google Scholar
  • 2 Young MJ, Bodien YG, Giacino JT. et al. The neuroethics of disorders of consciousness: a brief history of evolving ideas. Brain 2021; 144 (11) 3291-3310
    CrossrefPubMedSearch in Google Scholar
  • 3 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2 (7872): 81-84
    CrossrefPubMedSearch in Google Scholar
  • 4 Jennett B, Plum F. Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1972; 1 (7753): 734-737
    CrossrefPubMedSearch in Google Scholar
  • 5 Laureys S, Celesia GG, Cohadon F. et al; European Task Force on Disorders of Consciousness. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med 2010; 8: 68
    CrossrefPubMedSearch in Google Scholar
  • 6 Giacino JT, Ashwal S, Childs N. et al. The minimally conscious state: definition and diagnostic criteria. Neurology 2002; 58 (03) 349-353
    CrossrefPubMedSearch in Google Scholar
  • 7 Thibaut A, Bodien YG, Laureys S, Giacino JT. Minimally conscious state “plus”: diagnostic criteria and relation to functional recovery. J Neurol 2020; 267 (05) 1245-1254
    CrossrefPubMedSearch in Google Scholar
  • 8 Sherer M, Nakase-Thompson R, Yablon SA, Gontkovsky ST. Multidimensional assessment of acute confusion after traumatic brain injury. Arch Phys Med Rehabil 2005; 86 (05) 896-904
    CrossrefPubMedSearch in Google Scholar
  • 9 Giacino JT, Fins JJ, Laureys S, Schiff ND. Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol 2014; 10 (02) 99-114
    CrossrefPubMedSearch in Google Scholar
  • 10 Fischer D, Edlow BL, Giacino JT, Greer DM. Neuroprognostication: a conceptual framework. Nat Rev Neurol 2022; 18 (07) 419-427
    CrossrefPubMedSearch in Google Scholar
  • 11 Greer DM, Rosenthal ES, Wu O. Neuroprognostication of hypoxic-ischaemic coma in the therapeutic hypothermia era. Nat Rev Neurol 2014; 10 (04) 190-203
    CrossrefPubMedSearch in Google Scholar
  • 12 Giacino JT, Katz DI, Schiff ND. et al. Practice guideline update recommendations summary: disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology 2018; 91 (10) 450-460
    CrossrefPubMedSearch in Google Scholar
  • 13 Luauté J, Maucort-Boulch D, Tell L. et al. Long-term outcomes of chronic minimally conscious and vegetative states. Neurology 2010; 75 (03) 246-252
    CrossrefPubMedSearch in Google Scholar
  • 14 Estraneo A, Moretta P, Loreto V, Lanzillo B, Santoro L, Trojano L. Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology 2010; 75 (03) 239-245
    CrossrefPubMedSearch in Google Scholar
  • 15 Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N Engl J Med 1994; 330 (21) 1499-1508
    CrossrefPubMedSearch in Google Scholar
  • 16 van Erp WS, Lavrijsen JCM, van de Laar FA, Vos PE, Laureys S, Koopmans RT. The vegetative state/unresponsive wakefulness syndrome: a systematic review of prevalence studies. Eur J Neurol 2014; 21 (11) 1361-1368
    CrossrefPubMedSearch in Google Scholar
  • 17 Estraneo A, Magliacano A, Fiorenza S. et al. Risk factors for 2-year mortality in patients with prolonged disorders of consciousness: an international multicentre study. Eur J Neurol 2022; 29 (02) 390-399
    CrossrefPubMedSearch in Google Scholar
  • 18 Faugeras F, Rohaut B, Valente M. et al. Survival and consciousness recovery are better in the minimally conscious state than in the vegetative state. Brain Inj 2018; 32 (01) 72-77
    CrossrefPubMedSearch in Google Scholar
  • 19 Turgeon AF, Lauzier F, Simard JF. et al; Canadian Critical Care Trials Group. Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study. CMAJ 2011; 183 (14) 1581-1588
    CrossrefPubMedSearch in Google Scholar
  • 20 Davidson GH, Hamlat CA, Rivara FP, Koepsell TD, Jurkovich GJ, Arbabi S. Long-term survival of adult trauma patients. JAMA 2011; 305 (10) 1001-1007
    CrossrefPubMedSearch in Google Scholar
  • 21 Geocadin RG, Buitrago MM, Torbey MT, Chandra-Strobos N, Williams MA, Kaplan PW. Neurologic prognosis and withdrawal of life support after resuscitation from cardiac arrest. Neurology 2006; 67 (01) 105-108
    CrossrefPubMedSearch in Google Scholar
  • 22 Steinberg A, Abella BS, Gilmore EJ. et al. Frequency of withdrawal of life-sustaining therapy for perceived poor neurologic prognosis. Crit Care Explor 2021; 3 (07) e0487
    CrossrefPubMedSearch in Google Scholar
  • 23 Katz DI, Polyak M, Coughlan D, Nichols M, Roche A. Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up. Prog Brain Res 2009; 177: 73-88
    CrossrefPubMedSearch in Google Scholar
  • 24 Bagnato S, Boccagni C, Sant'Angelo A. et al. Long-lasting coma. Funct Neurol 2014; 29 (03) 201-205
    PubMedSearch in Google Scholar
  • 25 Ng YS, Chua KSG. States of severely altered consciousness: clinical characteristics, medical complications and functional outcome after rehabilitation. NeuroRehabilitation 2005; 20 (02) 97-105
    CrossrefPubMedSearch in Google Scholar
  • 26 Lammi MH, Smith VH, Tate RL, Taylor CM. The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury. Arch Phys Med Rehabil 2005; 86 (04) 746-754
    CrossrefPubMedSearch in Google Scholar
  • 27 Whyte J, Nakase-Richardson R, Hammond FM. et al. Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch Phys Med Rehabil 2013; 94 (10) 1855-1860
    CrossrefPubMedSearch in Google Scholar
  • 28 Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (2). N Engl J Med 1994; 330 (22) 1572-1579
    CrossrefPubMedSearch in Google Scholar
  • 29 Steppacher I, Kaps M, Kissler J. Will time heal? A long-term follow-up of severe disorders of consciousness. Ann Clin Transl Neurol 2014; 1 (06) 401-408
    CrossrefPubMedSearch in Google Scholar
  • 30 Noé E, Olaya J, Colomer C. et al. Current validity of diagnosis of permanent vegetative state: a longitudinal study in a sample of patients with altered states of consciousness. Neurología (Engl Ed) 2019; 34 (09) 589-595
    CrossrefPubMedSearch in Google Scholar
  • 31 Estraneo A, Moretta P, Loreto V, Santoro L, Trojano L. Clinical and neuropsychological long-term outcomes after late recovery of responsiveness: a case series. Arch Phys Med Rehabil 2014; 95 (04) 711-716
    CrossrefPubMedSearch in Google Scholar
  • 32 Nakase-Richardson R, Whyte J, Giacino JT. et al. Longitudinal outcome of patients with disordered consciousness in the NIDRR TBI Model Systems Programs. J Neurotrauma 2012; 29 (01) 59-65
    CrossrefPubMedSearch in Google Scholar
  • 33 Wilson BA, Gracey F, Bainbridge K. Cognitive recovery from “persistent vegetative state”: psychological and personal perspectives. Brain Inj 2001; 15 (12) 1083-1092
    CrossrefPubMedSearch in Google Scholar
  • 34 Voss HU, Uluğ AM, Dyke JP. et al. Possible axonal regrowth in late recovery from the minimally conscious state. J Clin Invest 2006; 116 (07) 2005-2011
    CrossrefPubMedSearch in Google Scholar
  • 35 Sarà M, Sacco S, Cipolla F. et al. An unexpected recovery from permanent vegetative state. Brain Inj 2007; 21 (01) 101-103
    CrossrefPubMedSearch in Google Scholar
  • 36 Dhamapurkar SK, Rose A, Florschutz G, Wilson BA. The natural history of continuing improvement in an individual after a long period of impaired consciousness: the story of I.J. Brain Inj 2016; 30 (02) 230-236
    CrossrefPubMedSearch in Google Scholar
  • 37 Faran S, Vatine JJ, Lazary A, Ohry A, Birbaumer N, Kotchoubey B. Late recovery from permanent traumatic vegetative state heralded by event-related potentials. J Neurol Neurosurg Psychiatry 2006; 77 (08) 998-1000
    CrossrefPubMedSearch in Google Scholar
  • 38 Childs NL, Mercer WN. Brief report: late improvement in consciousness after post-traumatic vegetative state. N Engl J Med 1996; 334 (01) 24-25
    CrossrefPubMedSearch in Google Scholar
  • 39 McMillan TM, Herbert CM. Further recovery in a potential treatment withdrawal case 10 years after brain injury. Brain Inj 2004; 18 (09) 935-940
    CrossrefPubMedSearch in Google Scholar
  • 40 Sancisi E, Battistini A, Di Stefano C. et al. Late recovery from post-traumatic vegetative state. Brain Inj 2009; 23 (02) 163-166
    CrossrefPubMedSearch in Google Scholar
  • 41 Illman NA, Crawford S. Late-recovery from “permanent” vegetative state in the context of severe traumatic brain injury: a case report exploring objective and subjective aspects of recovery and rehabilitation. Neuropsychol Rehabil 2018; 28 (08) 1360-1374
    CrossrefPubMedSearch in Google Scholar
  • 42 De Tanti A, Saviola D, Basagni B. et al. Recovery of consciousness after 7 years in vegetative state of non-traumatic origin: a single case study. Brain Inj 2016; 30 (08) 1029-1034
    CrossrefPubMedSearch in Google Scholar
  • 43 Estraneo A, De Bellis F, Masotta O. et al. Demographical and clinical indices for long-term evolution of patients in vegetative or in minimally conscious state. Brain Inj 2019; 33 (13–14): 1633-1639
    CrossrefPubMedSearch in Google Scholar
  • 44 van Erp WS, Lavrijsen JCM, Vos PE, Laureys S, Koopmans RTCM. Unresponsive wakefulness syndrome: outcomes from a vicious circle. Ann Neurol 2020; 87 (01) 12-18
    CrossrefPubMedSearch in Google Scholar
  • 45 Olaya J, Noé E, Navarro MD. et al. When, how, and to what extent are individuals with unresponsive wakefulness syndrome able to progress? Functional independence. Brain Sci 2020; 10 (12) E990
    CrossrefPubMedSearch in Google Scholar
  • 46 Grill E, Klein AM, Howell K. et al. Rationale and design of the prospective German registry of outcome in patients with severe disorders of consciousness after acute brain injury. Arch Phys Med Rehabil 2013; 94 (10) 1870-1876
    CrossrefPubMedSearch in Google Scholar
  • 47 Lopez-Rolon A, Vogler J, Howell K. et al. Severe disorders of consciousness after acquired brain injury: a single-centre long-term follow-up study. NeuroRehabilitation 2017; 40 (04) 509-517
    CrossrefPubMedSearch in Google Scholar
  • 48 Estraneo A, Loreto V, Masotta O, Pascarella A, Trojano L. Do medical complications impact long-term outcomes in prolonged disorders of consciousness?. Arch Phys Med Rehabil 2018; 99 (12) 2523-2531.e3
    CrossrefPubMedSearch in Google Scholar
  • 49 Giacino JT, Kalmar K. The vegetative and minimally conscious states: a comparison of clinical features and functional outcome. J Head Trauma Rehabil 1997; 12 (04) 36-51
    CrossrefPubMedSearch in Google Scholar
  • 50 Noé E, Olaya J, Navarro MD. et al. Behavioral recovery in disorders of consciousness: a prospective study with the Spanish version of the Coma Recovery Scale-Revised. Arch Phys Med Rehabil 2012; 93 (03) 428-433.e12
    CrossrefPubMedSearch in Google Scholar
  • 51 Chen WG, Li R, Zhang Y. et al. Recovery from prolonged disorders of consciousness: a dual-center prospective cohort study in China. World J Clin Cases 2020; 8 (12) 2520-2529
    CrossrefPubMedSearch in Google Scholar
  • 52 Levin HS, Saydjari C, Eisenberg HM. et al. Vegetative state after closed-head injury. A Traumatic Coma Data Bank Report. Arch Neurol 1991; 48 (06) 580-585
    CrossrefPubMedSearch in Google Scholar
  • 53 Schnakers C, Vanhaudenhuyse A, Giacino J. et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol 2009; 9: 35
    CrossrefPubMedSearch in Google Scholar
  • 54 Giacino JT, Schnakers C, Rodriguez-Moreno D, Kalmar K, Schiff N, Hirsch J. Behavioral assessment in patients with disorders of consciousness: gold standard or fool's gold?. Prog Brain Res 2009; 177: 33-48
    CrossrefPubMedSearch in Google Scholar
  • 55 Wang J, Hu X, Hu Z, Sun Z, Laureys S, Di H. The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated coma-recovery scale-revised assessment. BMC Neurol 2020; 20 (01) 343
    CrossrefPubMedSearch in Google Scholar
  • 56 Andrews K, Murphy L, Munday R, Littlewood C. Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ 1996; 313 (7048): 13-16
    CrossrefPubMedSearch in Google Scholar
  • 57 Løvstad M, Frøslie KF, Giacino JT, Skandsen T, Anke A, Schanke AK. Reliability and diagnostic characteristics of the JFK coma recovery scale-revised: exploring the influence of rater's level of experience. J Head Trauma Rehabil 2010; 25 (05) 349-356
    CrossrefPubMedSearch in Google Scholar
  • 58 Smart CM, Giacino JT, Cullen T. et al. A case of locked-in syndrome complicated by central deafness. Nat Clin Pract Neurol 2008; 4 (08) 448-453
    CrossrefPubMedSearch in Google Scholar
  • 59 Laureys S, Schiff ND. Coma and consciousness: paradigms (re)framed by neuroimaging. Neuroimage 2012; 61 (02) 478-491
    CrossrefPubMedSearch in Google Scholar
  • 60 Whyte J, Gosseries O, Chervoneva I. et al. Predictors of short-term outcome in brain-injured patients with disorders of consciousness. Prog Brain Res 2009; 177: 63-72
    CrossrefPubMedSearch in Google Scholar
  • 61 Nakase-Richardson R, McNamee S, Howe LL. et al. Descriptive characteristics and rehabilitation outcomes in active duty military personnel and veterans with disorders of consciousness with combat- and noncombat-related brain injury. Arch Phys Med Rehabil 2013; 94 (10) 1861-1869
    CrossrefPubMedSearch in Google Scholar
  • 62 Nekrasova J, Kanarskii M, Borisov I. et al. One-year demographical and clinical indices of patients with chronic disorders of consciousness. Brain Sci 2021; 11 (05) 651
    CrossrefPubMedSearch in Google Scholar
  • 63 Eilander HJ, Wijnen VJM, Scheirs JG, de Kort PL, Prevo AJ. Children and young adults in a prolonged unconscious state due to severe brain injury: outcome after an early intensive neurorehabilitation programme. Brain Inj 2005; 19 (06) 425-436
    CrossrefPubMedSearch in Google Scholar
  • 64 Kowalski RG, Hammond FM, Weintraub AH. et al. Recovery of Consciousness and functional outcome in moderate and severe traumatic brain injury. JAMA Neurol 2021; 78 (05) 548-557
    CrossrefPubMedSearch in Google Scholar
  • 65 McCrea MA, Giacino JT, Barber J. et al; TRACK-TBI Investigators. Functional outcomes over the first year after moderate to severe traumatic brain injury in the prospective, longitudinal TRACK-TBI study. JAMA Neurol 2021; 78 (08) 982-992
    CrossrefPubMedSearch in Google Scholar
  • 66 Howell K, Grill E, Klein AM, Straube A, Bender A. Rehabilitation outcome of anoxic-ischaemic encephalopathy survivors with prolonged disorders of consciousness. Resuscitation 2013; 84 (10) 1409-1415
    CrossrefPubMedSearch in Google Scholar
  • 67 Estraneo A, Moretta P, Loreto V. et al. Predictors of recovery of responsiveness in prolonged anoxic vegetative state. Neurology 2013; 80 (05) 464-470
    CrossrefPubMedSearch in Google Scholar
  • 68 Zandbergen EGJ, Hijdra A, Koelman JHTM. et al; PROPAC Study Group. Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology 2006; 66 (01) 62-68
    CrossrefPubMedSearch in Google Scholar
  • 69 Song M, Yang Y, Yang Z. et al. Prognostic models for prolonged disorders of consciousness: an integrative review. Cell Mol Life Sci 2020; 77 (20) 3945-3961
    CrossrefPubMedSearch in Google Scholar
  • 70 Whyte J, Katz D, Long D. et al. Predictors of outcome in prolonged posttraumatic disorders of consciousness and assessment of medication effects: a multicenter study. Arch Phys Med Rehabil 2005; 86 (03) 453-462
    CrossrefPubMedSearch in Google Scholar
  • 71 Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 2004; 85 (12) 2020-2029
    PubMedSearch in Google Scholar
  • 72 Lucca LF, Lofaro D, Pignolo L. et al. Outcome prediction in disorders of consciousness: the role of coma recovery scale revised. BMC Neurol 2019; 19 (01) 68
    CrossrefPubMedSearch in Google Scholar
  • 73 Edlow BL, Claassen J, Schiff ND, Greer DM. Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies. Nat Rev Neurol 2021; 17 (03) 135-156
    CrossrefPubMedSearch in Google Scholar
  • 74 Schiff ND. Cognitive motor dissociation following severe brain injuries. JAMA Neurol 2015; 72 (12) 1413-1415
    CrossrefPubMedSearch in Google Scholar
  • 75 Gosseries O, Zasler ND, Laureys S. Recent advances in disorders of consciousness: focus on the diagnosis. Brain Inj 2014; 28 (09) 1141-1150
    CrossrefPubMedSearch in Google Scholar
  • 76 Fernández-Espejo D, Rossit S, Owen AM. A thalamocortical mechanism for the absence of overt motor behavior in covertly aware patients. JAMA Neurol 2015; 72 (12) 1442-1450
    CrossrefPubMedSearch in Google Scholar
  • 77 Bruno MA, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol 2011; 258 (07) 1373-1384
    CrossrefPubMedSearch in Google Scholar
  • 78 Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD. Detecting awareness in the vegetative state. Science 2006; 313 (5792): 1402
    CrossrefPubMedSearch in Google Scholar
  • 79 Claassen J, Doyle K, Matory A. et al. Detection of brain activation in unresponsive patients with acute brain injury. N Engl J Med 2019; 380 (26) 2497-2505
    CrossrefPubMedSearch in Google Scholar
  • 80 Estraneo A, Loreto V, Guarino I. et al. Standard EEG in diagnostic process of prolonged disorders of consciousness. Clin Neurophysiol 2016; 127 (06) 2379-2385
    CrossrefPubMedSearch in Google Scholar
  • 81 Sitt JD, King JR, El Karoui I. et al. Large scale screening of neural signatures of consciousness in patients in a vegetative or minimally conscious state. Brain 2014; 137 (Pt 8): 2258-2270
    CrossrefPubMedSearch in Google Scholar
  • 82 Schorr B, Schlee W, Arndt M, Bender A. Coherence in resting-state EEG as a predictor for the recovery from unresponsive wakefulness syndrome. J Neurol 2016; 263 (05) 937-953
    CrossrefPubMedSearch in Google Scholar
  • 83 Chennu S, Annen J, Wannez S. et al. Brain networks predict metabolism, diagnosis and prognosis at the bedside in disorders of consciousness. Brain 2017; 140 (08) 2120-2132
    CrossrefPubMedSearch in Google Scholar
  • 84 Arnaldi D, Terzaghi M, Cremascoli R. et al. The prognostic value of sleep patterns in disorders of consciousness in the sub-acute phase. Clin Neurophysiol 2016; 127 (02) 1445-1451
    CrossrefPubMedSearch in Google Scholar
  • 85 Kempny AM, James L, Yelden K. et al. Patients with a severe prolonged disorder of consciousness can show classical EEG responses to their own name compared with others' names. Neuroimage Clin 2018; 19: 311-319
    CrossrefPubMedSearch in Google Scholar
  • 86 Kotchoubey B, Lang S, Mezger G. et al. Information processing in severe disorders of consciousness: vegetative state and minimally conscious state. Clin Neurophysiol 2005; 116 (10) 2441-2453
    CrossrefPubMedSearch in Google Scholar
  • 87 Qin P, Di H, Yan X. et al. Mismatch negativity to the patient's own name in chronic disorders of consciousness. Neurosci Lett 2008; 448 (01) 24-28
    CrossrefPubMedSearch in Google Scholar
  • 88 Wijnen VJM, van Boxtel GJM, Eilander HJ, de Gelder B. Mismatch negativity predicts recovery from the vegetative state. Clin Neurophysiol 2007; 118 (03) 597-605
    CrossrefPubMedSearch in Google Scholar
  • 89 Steppacher I, Eickhoff S, Jordanov T, Kaps M, Witzke W, Kissler J. N400 predicts recovery from disorders of consciousness. Ann Neurol 2013; 73 (05) 594-602
    CrossrefPubMedSearch in Google Scholar
  • 90 Steppacher I, Fuchs P, Kaps M, Nussbeck FW, Kissler J. A tree of life? Multivariate logistic outcome-prediction in disorders of consciousness. Brain Inj 2020; 34 (03) 399-406
    CrossrefPubMedSearch in Google Scholar
  • 91 Albrechtsen SS, Riis RGC, Amiri M. et al. Impact of MRI on decision-making in ICU patients with disorders of consciousness. Behav Brain Res 2022; 421: 113729
    CrossrefPubMedSearch in Google Scholar
  • 92 Kampfl A, Schmutzhard E, Franz G. et al. Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging. Lancet 1998; 351 (9118): 1763-1767
    CrossrefPubMedSearch in Google Scholar
  • 93 Kampfl A, Franz G, Aichner F. et al. The persistent vegetative state after closed head injury: clinical and magnetic resonance imaging findings in 42 patients. J Neurosurg 1998; 88 (05) 809-816
    CrossrefPubMedSearch in Google Scholar
  • 94 Clarençon F, Bardinet É, Martinerie J. et al; Neuro Imaging for Coma Emergence and Recovery (NICER) consortium. Lesions in deep gray nuclei after severe traumatic brain injury predict neurologic outcome. PLoS One 2017; 12 (11) e0186641
    CrossrefPubMedSearch in Google Scholar
  • 95 Galanaud D, Perlbarg V, Gupta R. et al; Neuro Imaging for Coma Emergence and Recovery Consortium. Assessment of white matter injury and outcome in severe brain trauma: a prospective multicenter cohort. Anesthesiology 2012; 117 (06) 1300-1310
    CrossrefPubMedSearch in Google Scholar
  • 96 Luyt CE, Galanaud D, Perlbarg V. et al; Neuro Imaging for Coma Emergence and Recovery Consortium. Diffusion tensor imaging to predict long-term outcome after cardiac arrest: a bicentric pilot study. Anesthesiology 2012; 117 (06) 1311-1321
    CrossrefPubMedSearch in Google Scholar
  • 97 Fernández-Espejo D, Bekinschtein T, Monti MM. et al. Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state. Neuroimage 2011; 54 (01) 103-112
    CrossrefPubMedSearch in Google Scholar
  • 98 Sidaros A, Engberg AW, Sidaros K. et al. Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: a longitudinal study. Brain 2008; 131 (Pt 2): 559-572
    CrossrefPubMedSearch in Google Scholar
  • 99 Horwitz B. The elusive concept of brain connectivity. Neuroimage 2003; 19 (2 Pt 1): 466-470
    CrossrefPubMedSearch in Google Scholar
  • 100 Bodien YG, Threlkeld ZD, Edlow BL. Default mode network dynamics in covert consciousness. Cortex 2019; 119: 571-574
    CrossrefPubMedSearch in Google Scholar
  • 101 Vanhaudenhuyse A, Noirhomme Q, Tshibanda LJF. et al. Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients. Brain 2010; 133 (Pt 1): 161-171
    CrossrefPubMedSearch in Google Scholar
  • 102 Demertzi A, Antonopoulos G, Heine L. et al. Intrinsic functional connectivity differentiates minimally conscious from unresponsive patients. Brain 2015; 138 (Pt 9): 2619-2631
    CrossrefPubMedSearch in Google Scholar
  • 103 Wu X, Zou Q, Hu J. et al. Intrinsic functional connectivity patterns predict consciousness level and recovery outcome in acquired brain injury. J Neurosci 2015; 35 (37) 12932-12946
    CrossrefPubMedSearch in Google Scholar
  • 104 Soddu A, Vanhaudenhuyse A, Bahri MA. et al. Identifying the default-mode component in spatial IC analyses of patients with disorders of consciousness. Hum Brain Mapp 2012; 33 (04) 778-796
    CrossrefPubMedSearch in Google Scholar
  • 105 Di HB, Yu SM, Weng XC. et al. Cerebral response to patient's own name in the vegetative and minimally conscious states. Neurology 2007; 68 (12) 895-899
    CrossrefPubMedSearch in Google Scholar
  • 106 Di H, Boly M, Weng X, Ledoux D, Laureys S. Neuroimaging activation studies in the vegetative state: predictors of recovery?. Clin Med (Lond) 2008; 8 (05) 502-507
    CrossrefPubMedSearch in Google Scholar
  • 107 Majerus S, Bruno MA, Schnakers C, Giacino JT, Laureys S. The problem of aphasia in the assessment of consciousness in brain-damaged patients. Prog Brain Res 2009; 177: 49-61
    CrossrefPubMedSearch in Google Scholar
  • 108 Stender J, Gosseries O, Bruno MA. et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Lancet 2014; 384 (9942): 514-522
    CrossrefPubMedSearch in Google Scholar
  • 109 Stender J, Kupers R, Rodell A. et al. Quantitative rates of brain glucose metabolism distinguish minimally conscious from vegetative state patients. J Cereb Blood Flow Metab 2015; 35 (01) 58-65
    CrossrefPubMedSearch in Google Scholar
  • 110 Golkowski D, Merz K, Mlynarcik C. et al. Simultaneous EEG-PET-fMRI measurements in disorders of consciousness: an exploratory study on diagnosis and prognosis. J Neurol 2017; 264 (09) 1986-1995
    CrossrefPubMedSearch in Google Scholar
  • 111 Hermann B, Stender J, Habert MO. et al. Multimodal FDG-PET and EEG assessment improves diagnosis and prognostication of disorders of consciousness. Neuroimage Clin 2021; 30: 102601
    CrossrefPubMedSearch in Google Scholar
  • 112 Oder W, Goldenberg G, Podreka I, Deecke L. HM-PAO-SPECT in persistent vegetative state after head injury: prognostic indicator of the likelihood of recovery?. Intensive Care Med 1991; 17 (03) 149-153
    CrossrefPubMedSearch in Google Scholar
  • 113 Nayak P, Mahapatra AK. Single photon emission computed tomography scanning: a predictor of outcome in vegetative state of head injury. J Neurosci Rural Pract 2011; 2 (01) 12-16
    Thieme ConnectPubMedSearch in Google Scholar
  • 114 Beuthien-Baumann B, Handrick W, Schmidt T. et al. Persistent vegetative state: evaluation of brain metabolism and brain perfusion with PET and SPECT. Nucl Med Commun 2003; 24 (06) 643-649
    CrossrefPubMedSearch in Google Scholar
  • 115 Rosanova M, Gosseries O, Casarotto S. et al. Recovery of cortical effective connectivity and recovery of consciousness in vegetative patients. Brain 2012; 135 (Pt 4): 1308-1320
    CrossrefPubMedSearch in Google Scholar
  • 116 Ragazzoni A, Pirulli C, Veniero D. et al. Vegetative versus minimally conscious states: a study using TMS-EEG, sensory and event-related potentials. PLoS One 2013; 8 (02) e57069
    CrossrefPubMedSearch in Google Scholar
  • 117 Casarotto S, Comanducci A, Rosanova M. et al. Stratification of unresponsive patients by an independently validated index of brain complexity. Ann Neurol 2016; 80 (05) 718-729
    CrossrefPubMedSearch in Google Scholar
  • 118 Jöbsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 1977; 198 (4323): 1264-1267
    CrossrefPubMedSearch in Google Scholar
  • 119 Boas DA, Dale AM, Franceschini MA. Diffuse optical imaging of brain activation: approaches to optimizing image sensitivity, resolution, and accuracy. Neuroimage 2004; 23 (Suppl. 01) S275-S288
    CrossrefPubMedSearch in Google Scholar
  • 120 Kempny AM, James L, Yelden K. et al. Functional near infrared spectroscopy as a probe of brain function in people with prolonged disorders of consciousness. Neuroimage Clin 2016; 12: 312-319
    CrossrefPubMedSearch in Google Scholar
  • 121 Porcaro C, Nemirovsky IE, Riganello F. et al. Diagnostic developments in differentiating unresponsive wakefulness syndrome and the minimally conscious state. Front Neurol 2022; 12: 778951
    CrossrefPubMedSearch in Google Scholar
  • 122 Fernández-Espejo D, Junque C, Cruse D. et al. Combination of diffusion tensor and functional magnetic resonance imaging during recovery from the vegetative state. BMC Neurol 2010; 10: 77
    CrossrefPubMedSearch in Google Scholar
  • 123 Monti MM, Schnakers C. Flowchart for implementing advanced imaging and electrophysiology in patients with disorders of consciousness: to fMRI or not to fMRI?. [Miscellaneous Article] Neurology 2022; 98 (11) 452-459
    CrossrefPubMedSearch in Google Scholar
  • 124 Bao W, He F, Gao J, Meng F, Zou H, Luo B. Alpha-1-antitrypsin: a novel predictor for long-term recovery of chronic disorder of consciousness. Expert Rev Mol Diagn 2018; 18 (03) 307-313
    CrossrefPubMedSearch in Google Scholar
  • 125 Peeters M, Page G, Maloteaux JM, Hermans E. Hypersensitivity of dopamine transmission in the rat striatum after treatment with the NMDA receptor antagonist amantadine. Brain Res 2002; 949 (1–2): 32-41
    CrossrefPubMedSearch in Google Scholar
  • 126 Meythaler JM, Brunner RC, Johnson A, Novack TA. Amantadine to improve neurorecovery in traumatic brain injury-associated diffuse axonal injury: a pilot double-blind randomized trial. J Head Trauma Rehabil 2002; 17 (04) 300-313
    CrossrefPubMedSearch in Google Scholar
  • 127 Schneider WN, Drew-Cates J, Wong TM, Dombovy ML. Cognitive and behavioural efficacy of amantadine in acute traumatic brain injury: an initial double-blind placebo-controlled study. Brain Inj 1999; 13 (11) 863-872
    CrossrefPubMedSearch in Google Scholar
  • 128 Giacino JT, Whyte J, Bagiella E. et al. Placebo-controlled trial of amantadine for severe traumatic brain injury. N Engl J Med 2012; 366 (09) 819-826
    CrossrefPubMedSearch in Google Scholar
  • 129 Hammond FM, Sherer M, Malec JF. et al. Amantadine did not positively impact cognition in chronic traumatic brain injury: a multi-site, randomized, controlled trial. J Neurotrauma 2018; 35 (19) 2298-2305
    CrossrefPubMedSearch in Google Scholar
  • 130 Ghalaenovi H, Fattahi A, Koohpayehzadeh J. et al. The effects of amantadine on traumatic brain injury outcome: a double-blind, randomized, controlled, clinical trial. Brain Inj 2018; 32 (08) 1050-1055
    CrossrefPubMedSearch in Google Scholar
  • 131 Shafiee S, Ehteshami S, Moosazadeh M, Aghapour S, Haddadi K. Placebo-controlled trial of oral amantadine and zolpidem efficacy on the outcome of patients with acute severe traumatic brain injury and diffuse axonal injury. Caspian J Intern Med 2022; 13 (01) 113-121
    PubMedSearch in Google Scholar
  • 132 Whyte J, Rajan R, Rosenbaum A. et al. Zolpidem and restoration of consciousness. Am J Phys Med Rehabil 2014; 93 (02) 101-113
    CrossrefPubMedSearch in Google Scholar
  • 133 Kim YW, Shin JC, An YS. Effects of methylphenidate on cerebral glucose metabolism in patients with impaired consciousness after acquired brain injury. Clin Neuropharmacol 2009; 32 (06) 335-339
    CrossrefPubMedSearch in Google Scholar
  • 134 Krimchansky BZ, Keren O, Sazbon L, Groswasser Z. Differential time and related appearance of signs, indicating improvement in the state of consciousness in vegetative state traumatic brain injury (VS-TBI) patients after initiation of dopamine treatment. Brain Inj 2004; 18 (11) 1099-1105
    CrossrefPubMedSearch in Google Scholar
  • 135 Passler MA, Riggs RV. Positive outcomes in traumatic brain injury-vegetative state: patients treated with bromocriptine. Arch Phys Med Rehabil 2001; 82 (03) 311-315
    CrossrefPubMedSearch in Google Scholar
  • 136 Fridman EA, Krimchansky BZ, Bonetto M. et al. Continuous subcutaneous apomorphine for severe disorders of consciousness after traumatic brain injury. Brain Inj 2010; 24 (04) 636-641
    CrossrefPubMedSearch in Google Scholar
  • 137 Manganotti P, Formaggio E, Storti SF. et al. Effect of high-frequency repetitive transcranial magnetic stimulation on brain excitability in severely brain-injured patients in minimally conscious or vegetative state. Brain Stimul 2013; 6 (06) 913-921
    CrossrefPubMedSearch in Google Scholar
  • 138 Schiff ND, Giacino JT, Kalmar K. et al. Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature 2007; 448 (7153): 600-603
    CrossrefPubMedSearch in Google Scholar
  • 139 Thibaut A, Bruno MA, Ledoux D, Demertzi A, Laureys S. tDCS in patients with disorders of consciousness: sham-controlled randomized double-blind study. Neurology 2014; 82 (13) 1112-1118
    CrossrefPubMedSearch in Google Scholar
  • 140 Corazzol M, Lio G, Lefevre A. et al. Restoring consciousness with vagus nerve stimulation. Curr Biol 2017; 27 (18) R994-R996
    CrossrefPubMedSearch in Google Scholar
  • 141 Cincotta M, Giovannelli F, Chiaramonti R. et al. No effects of 20 Hz-rTMS of the primary motor cortex in vegetative state: a randomised, sham-controlled study. Cortex 2015; 71: 368-376
    CrossrefPubMedSearch in Google Scholar
  • 142 Pape TLB, Rosenow JM, Steiner M. et al. Placebo-controlled trial of familiar auditory sensory training for acute severe traumatic brain injury: a preliminary report. Neurorehabil Neural Repair 2015; 29 (06) 537-547
    CrossrefPubMedSearch in Google Scholar
  • 143 Schnakers C, Magee WL, Harris B. Sensory stimulation and music therapy programs for treating disorders of consciousness. Front Psychol 2016; 7: 297
    CrossrefPubMedSearch in Google Scholar
  • 144 Payne K, Taylor RM, Stocking C, Sachs GA. Physicians' attitudes about the care of patients in the persistent vegetative state: a national survey. Ann Intern Med 1996; 125 (02) 104-110
    CrossrefPubMedSearch in Google Scholar
  • 145 Kuehlmeyer K, Palmour N, Riopelle RJ, Bernat JL, Jox RJ, Racine E. Physicians' attitudes toward medical and ethical challenges for patients in the vegetative state: comparing Canadian and German perspectives in a vignette survey. BMC Neurol 2014; 14: 119
    CrossrefPubMedSearch in Google Scholar
  • 146 Graham M, Naci L. Well-being after severe brain injury: what counts as good recovery?. Camb Q Healthc Ethics 2021; 30 (04) 613-622
    CrossrefPubMedSearch in Google Scholar
  • 147 Jones JM, Haslam SA, Jetten J, Williams WH, Morris R, Saroyan S. That which doesn't kill us can make us stronger (and more satisfied with life): the contribution of personal and social changes to well-being after acquired brain injury. Psychol Health 2011; 26 (03) 353-369
    CrossrefPubMedSearch in Google Scholar
  • 148 Weil AG, Rahme R, Moumdjian R, Bouthillier A, Bojanowski MW. Quality of life following hemicraniectomy for malignant MCA territory infarction. Can J Neurol Sci 2011; 38 (03) 434-438
    CrossrefPubMedSearch in Google Scholar
  • 149 Rahme R, Zuccarello M, Kleindorfer D, Adeoye OM, Ringer AJ. Decompressive hemicraniectomy for malignant middle cerebral artery territory infarction: is life worth living?. J Neurosurg 2012; 117 (04) 749-754
    CrossrefPubMedSearch in Google Scholar
  • 150 Kreitzer NP, Hart K, Lindsell CJ. et al. A comparison of satisfaction with life and the glasgow outcome scale-extended after traumatic brain injury: an analysis of the TRACK-TBI pilot study. J Head Trauma Rehabil 2019; 34 (03) E10-E17
    CrossrefPubMedSearch in Google Scholar
  • 151 Jacobsson L, Lexell J. Life satisfaction 6-15 years after a traumatic brain injury. J Rehabil Med 2013; 45 (10) 1010-1015
    CrossrefPubMedSearch in Google Scholar
  • 152 Mailhan L, Azouvi P, Dazord A. Life satisfaction and disability after severe traumatic brain injury. Brain Inj 2005; 19 (04) 227-238
    CrossrefPubMedSearch in Google Scholar
  • 153 Rauen K, Reichelt L, Probst P. et al. Quality of life up to 10 years after traumatic brain injury: a cross-sectional analysis. Health Qual Life Outcomes 2020; 18 (01) 166
    CrossrefPubMedSearch in Google Scholar
  • 154 von Steinbüchel N, Wilson L, Gibbons H. et al; QOLIBRI Task Force. Quality of Life after Brain Injury (QOLIBRI): scale validity and correlates of quality of life. J Neurotrauma 2010; 27 (07) 1157-1165
    CrossrefPubMedSearch in Google Scholar
  • 155 Machamer J, Temkin N, Dikmen S. Health-related quality of life in traumatic brain injury: is a proxy report necessary?. J Neurotrauma 2013; 30 (22) 1845-1851
    CrossrefPubMedSearch in Google Scholar
  • 156 Anke A, Andelic N, Skandsen T. et al. Functional recovery and life satisfaction in the first year after severe traumatic brain injury: a prospective multicenter study of a norwegian national cohort. J Head Trauma Rehabil 2015; 30 (04) E38-E49
    CrossrefPubMedSearch in Google Scholar
  • 157 Scholten AC, Haagsma JA, Andriessen TMJC. et al. Health-related quality of life after mild, moderate and severe traumatic brain injury: patterns and predictors of suboptimal functioning during the first year after injury. Injury 2015; 46 (04) 616-624
    CrossrefPubMedSearch in Google Scholar
  • 158 Juengst SB, Adams LM, Bogner JA. et al. Trajectories of life satisfaction after TBI: Influence of life roles, age, cognitive disability, and depressive symptoms. Rehabil Psychol 2015; 60 (04) 353-364
    CrossrefPubMedSearch in Google Scholar
  • 159 Saban KL, Smith BM, Collins EG, Pape TLB. Sex differences in perceived life satisfaction and functional status one year after severe traumatic brain injury. J Womens Health (Larchmt) 2011; 20 (02) 179-186
    CrossrefPubMedSearch in Google Scholar
  • 160 Borgen IMH, Kleffelgård I, Hauger SL. et al. Patient-reported problem areas in chronic traumatic brain injury. J Head Trauma Rehabil 2022; 37 (05) E336-E345
    CrossrefPubMedSearch in Google Scholar
  • 161 Stenberg M, Stålnacke BM, Saveman BI. Health and well-being of persons of working age up to seven years after severe traumatic brain injury in Northern Sweden: a mixed method study. J Clin Med 2022; 11 (05) 1306
    CrossrefPubMedSearch in Google Scholar
  • 162 Tung J, Speechley KN, Gofton T. et al. Towards the assessment of quality of life in patients with disorders of consciousness. Qual Life Res 2020; 29 (05) 1217-1227
    CrossrefPubMedSearch in Google Scholar
  • 163 Sharma-Virk M, van Erp WS, Lavrijsen JCM, Koopmans RTCM. Intensive neurorehabilitation for patients with prolonged disorders of consciousness: protocol of a mixed-methods study focusing on outcomes, ethics and impact. BMC Neurol 2021; 21 (01) 133
    CrossrefPubMedSearch in Google Scholar
  • 164 Kotchoubey B, Pavlov YG. A systematic review and meta-analysis of the relationship between brain data and the outcome in disorders of consciousness. Front Neurol 2018; 9: 315
    CrossrefPubMedSearch in Google Scholar
  • 165 Dimyan MA, Dobkin BH, Cohen LG. Emerging subspecialties: neurorehabilitation: training neurologists to retrain the brain. Neurology 2008; 70 (16) e52-e54
    CrossrefPubMedSearch in Google Scholar